War and Health Insurance Policy in Japan and the United States

World War II to Postwar Reconstruction

Takakazu Yamagishi

Publication Year: 2011

World War II forced extensive and comprehensive social and political changes on nations across the globe. This comparative examination of health insurance in the United States and Japan during and after the war explores how World War II shaped the health care systems of both countries.
To compare the development of health insurance in the two countries, Takakazu Yamagishi discusses the impact of total war on four factors: political structure, interest group politics, political culture, and policy feedback. During World War II, the U.S. and Japanese governments realized that healthy soldiers, workers, mothers, and children were vital to national survival. While both countries adopted new, expansive national insurance policies as part of their mobilization efforts, they approached doing so in different ways and achieved near-opposite results. In the United States, private insurance became the predominant means of insuring people, save for a few government-run programs. Japan, meanwhile, created a near-universal, public insurance system. After the war, their different policy paths were consolidated. Yamagishi argues that these disparate outcomes were the result of each nation’s respective war experience. He looks closely at postwar Japan and investigates how political struggles between the American occupation authority and U.S. domestic forces, such as the American Medical Association, helped solidify the existing Japanese health insurance system.
Original and tightly argued, this volume makes a strong case for treating total war as a central factor in understanding how the health insurance systems of the two nations grew, while bearing in mind the dual nature of government intervention—however slight—in health care. Those interested in debates about health care in Japan, the United States, and other countries, and especially scholars of comparative political development, will appreciate and learn from Yamagishi’s study.

Cover

Contents

Preface

I grew up and currently live in Japan, but I lived in the United States for about eight years. When I was at the Johns Hopkins University studying for my doctoral degree, I played softball on the political science team. Once, while running to catch a ball, I felt a sharp pain in my knee. It turned out that I had hurt a knee ligament and had to see a doctor. At that time, I knew almost nothing about ...

Acknowledgments

With this, my first book, I remember all the important mentors, friends, and family members who helped me get here. I was born in a rural area of Japan, Fukui Prefecture, where we were rarely exposed to foreign people and cultures. But my parents, Shigeo and Michiyo Yamagishi, helped me to open as many windows of curiosity as possible. When I was young, my mother always told me ...

Introduction

Approximately fifty million people died in World War II. Yet, despite this massive devastation, the war was also responsible for policies that would improve the health of people. World War II forced nations like Japan and the United States to realize that healthy soldiers, workers, mothers, and children were vital for their survival. Health insurance, which assured people’s access to medical ...

PART I: PREWAR DEVELOPMENT OF HEALTH INSURANCE

Japan and the United States had only limited health insurance before they entered World War II in 1937 and 1941, respectively. In the 1910s both Japan and the United States sought to learn about health insurance from European welfare states, such as Great Britain. However, health insurance coverage remained at only 5.7% in Japan (1936) and 9.3% in the United States (1940), while ...

1 Learning from Germany: Japan before 1937

In 1868, the government of the Tokugawa Shogunate ended 268 years of rule. After it abolished the feudal social and political system, the new Japanese government sought to modernize Japan by emulating Western countries. The government designed its new constitution, military system, and industrial policy by learning from them. The idea of health insurance also came to Japan, and the ...

2 Catching Up with Europe: The United States before 1941

Through the first half of the nineteenth century, the United States lagged behind major European countries, such as Britain and France, in degree of industrialization. By the late nineteenth century, however, the United States had become an important economic power in the world. As the country became more industrialized, the United States faced unpre ce dented social problems. Urban ...

PART II: HEALTH SECURITY AS NATIONAL SECURITY

This second part of the book shows that World War II (1937 to 1945 for Japan and 1941 to 1945 for the United States) led to the expansion of health insurance in both countries. It also explains what made the two countries adopt diﬀerent health insurance policies by the end of the war. It argues that war mobilization changed the politics of health insurance because health...

3 Creating a Public Health Insurance System: Japan, 1937–1945

In July 1937, the Marco Polo Bridge Incident opened the battle between Japan and China. Subsequently, by its attack on Pearl Harbor in December 1941, Japan started a war against the Allied Powers. In Japan, the periods before and after Pearl Harbor have often been considered separately; the former is often called the (Second) Sino-Japanese War, and the latter is called the Pacific War. ...

President Franklin D. Roosevelt asked Congress to declare war on December 8, 1941, stating, “Yesterday, December 7, 1941— a date which will live in infamy— the United States of America was suddenly and deliberately attacked by naval and air forces of the Empire of Japan.”1 Japan’s attack on Pearl Harbor oﬃcially brought the United States into World War II. By that time, however, the...

PART III: HEALTH INSURANCE IN THE POSTWAR PERIOD

Hostilities in World War II ended on August 15, 1945, when Japan unconditionally surrendered to the Allied Nations. By that time, as the previous two chapters show, Japan and the United States had adopted diﬀerent health insurance systems. Japan had a public health insurance system that was based on multiple programs; the United States had a hybrid health insurance system that relied ...

After the war, the United States faced a number of important questions. How should the United States deal with the war time public health insurance programs, such as the one for veterans? Should the United States try to finish the task that Franklin D. Roosevelt had left: the introduction of universal health insurance? How should the United States cope with the rise of private health ...

6 Restoring the Public Health Insurance System: Japan, 1945–1952

During the early period of World War II, Japan created the National Health Insurance Law (NHI), the White-Collar Workers’ Health Insurance Law, and the Seamen’s Insurance Law. Later in the war, Japan amended the Health Insurance Law and the NHI to expand their coverage. As a result, by the end of the war Japan had adopted a public health insurance system that oﬀered near-universal ...

Conclusion

It is a commonplace that World War II influenced society, the economy, and the politics of war participants. However, scholars tend to deal with the war as a black box, reluctant to theorize seriously about how, when, and to what degree the war aﬀected these aspects of life. This book contributes to this broad...

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